Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

484 Diarrhea

Osmotic Diarrhea

■Disaccharidase deficiency, small intestinal mucosal disease, laxa-

tive abuse, medication/ETOH induced, malabsorption syndromes,

lymphatic obstruction, intestinal resection, bacterial overgrowth

Secretory Diarrhea

■Celiac sprue, enterotoxins, endocrine tumors, medication, neo-

plasms, colitis, fatty acid/bile acid malabsorption, hyperthyroidism,

collagen vascular disease

Diarrhea Due to Dysmotility

■IBS, diabetic diarrhea, blind loop syndrome, malignant carcinoid,

post vagotomy, cholecystectomy, gastrectomy, ileocecal valve

■resection

management

What to Do First

■Assess acuteness, severity of diarrhea, complications and candidacy

for therapy

■Determine organic vs functional disorder

General Measures

■Correction of electrolyte disorders and anemia

■Rehydration

■Avoidance of offending agent if possible

■Nutritional support

specific therapy

■Antibiotics for infectious etiologies: (see section on infectious diar-

rhea) especially in immunosuppressed patients or those with valvu-

lar heart disease, orthopedic prosthesis, or malignancies

■Antimotility agents if not detrimental (see below)

■Octreotide for endocrine tumors

■Cholestyramine for bile acid diarrhea

■Anti-inflammatory agents for IBD/microscopic colitis: glucocorti-

coids, 5ASA compounds, azathioprine, 6MPClonidine for diabetic

diarrhea

■Enzyme replacement therapy for disaccharidase deficiency and pan-

creatic insufficiency

Side Effects & Contraindications

■Antibiotics: may cause prolongation of microorganism excretion

time, allergic reactions, worsening diarrhea

➣Contraindication: history of allergy to medication